Bridge demolition and maintenance are leading causes of lead
poisoning among workers in the United States (1-5). In June 1992,
a local health department in Georgia detected elevated blood lead
levels (BLLs) in four demolition workers. This report summarizes
the investigation of these cases.

In February 1992, a temporary-service company was
subcontracted by a steel corporation to cut apart steel beams that
had been removed from a local bridge. Four men were hired; one
worker, aged 54 years, began work in late February; two, aged 36
and 28 years, in March; and one, aged 24 years, in early April. All
four were immigrants from Mexico; only two spoke English. The work
was performed outdoors, without protective equipment or training,
using oxy-acetylene flame-cutting torches.

In April, all four workers reported light-headedness and
shortness of breath from the metal fumes, requiring frequent
fresh-air breaks during the day. In early May, all four workers
developed a variety of symptoms including headache, dizziness,
fatigue, sleep disturbance, confusion, forgetfulness, arthralgia,
and abdominal pain. Paper masks were provided to the workers in
late May by the steel company; however, because these became
blocked within hours by the accumulation of dust, the workers
discarded them. The severity of symptoms intensified through June,
with nausea, vomiting, constipation, weakness, shortness of breath,
loss of balance, and nervousness. The 36-year-old worker left
employment for 3 weeks (from mid-June through early July) because
of his symptoms.

As part of an annual risk-management assessment by the steel
company's insurance carrier, personal air sampling was conducted
April 30 for one of the four workers; this specimen measured an
airborne lead concentration of 525 ug/m3, more than 10 times the
Occupational Safety and Health Administration (OSHA) permissible
exposure limit (PEL) of 50 ug/m3 for general industry *. In early
June, the steel company suggested BLL examinations of the workers;
their BLLs, measured at the local health department, were 93, 90,
59, and 66 ug/dL for the 54-, 28-, 24-, and 36-year-old men,
respectively. The workers' employment was terminated in late June
on receipt of the test results by the company.

In follow-up to the BLL results, in mid-June the health
department investigated each worker's household, using a standard
protocol of visual inspection and portable radiographic
fluorescence readings of window sills, walls, and trim; no
environmental sources of lead exposure were identified. BLLs were
obtained from three children who resided in the homes; all had
levels less than 10 ug/dL, which is below the CDC BLL of concern
for children (6).

The health department recommended that the workers promptly
seek medical evaluation and care; however, because they had no
medical insurance and both the subcontractor and the steel company
declined to assume the costs of treatment, the workers initially
delayed seeking medical treatment. They subsequently contacted an
attorney, who initiated worker's compensation proceedings and
arranged for a local hospital to admit them for treatment. Each
worker received three 5-day chelation treatments with intravenous
calcium disodium ethylenediamine tetraacetic acid approximately 15
days apart. All four reported improvement but continued to
experience memory deficits, arthralgias, headaches, dizziness,
and/or sleep disturbances.

The health department also recommended that the workers
request an OSHA inspection of the worksite. Findings from the
inspection of the steel company on July 15 resulted in citations
for violations of the medical removal protection and worker
training provisions of OSHA's lead standard *. OSHA inspectors also
investigated work conditions at the bridge from which the beams
were removed; the demolition company was cited for excessive lead
exposures (based on the construction industry PEL of 200 ug/m3 **),
failure to provide personal protective equipment, and failure to
monitor workplace conditions.

On December 14, 1992, the workers were evaluated at a
university-based occupational medicine clinic. Physical
examinations of three workers were normal; the 54-year-old worker
was markedly depressed with evidence of neurologic abnormalities,
including a strongly positive Romberg test and marked dysnomia. BLL
measurements were 27, 25, 13, and 16 ug/dL for the 54-, 28-, 24-,
and 36-year-old workers, respectively. No further treatment was
recommended, but follow-up BLL monitoring was planned.

Editorial Note

Editorial Note: An estimated 90,000 bridges in the United States
are coated with lead-containing paints (7). Because of maintenance
and reconstruction requirements, lead exposure is a continuing
occupational health hazard for construction and demolition workers.
Previous cases of lead poisoning associated with similar work have
been characterized by extremely high BLLs in affected workers,
which developed after brief exposures and, in some instances, were
unresponsive to chelation therapy.

The findings in this report are consistent with other studies
that indicate that minority groups are disproportionately exposed
to lead and other occupational hazards (8,9). In addition, the
hazardous process described in this report (flame-cutting or
burning of paint-coated steel beams) had been subcontracted to a
smaller company by a larger, well-established firm. Such
subcontracting is common in the construction industry but often
concentrates hazards among workers with limited access to
appropriate training, personal protective equipment, and other
safety and health measures.

Construction workers are subject to highly variable exposures,
and high worker-turnover rates in the construction workforce may
pose special hazards for construction workers. Effective June 3,
1993, a new interim final OSHA standard on "Lead Exposure in
Construction" extends to workers in the construction trades the
basic health and safety provisions of the OSHA lead standard for
general industry, such as requirements for medical monitoring and
medical removal protection (10).

The response of the health department to the lead exposure in
these workers was prompt and effective. However, the limitations of
the interventions available and the persistence of the workers'
symptoms underscore the need for primary prevention -- including
portable local ventilation, personal protective equipment, personal
hygiene measures, and worker training -- during bridge renovation
and
related demolition work.

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